A therapy intake form has one job: give you enough background before the first session that you can spend the hour on the person, not on paperwork. Most forms you'll find online are one practice's eight-page PDF, written for that practice's clients, state and billing. This guide gives you a better starting point: what to ask and why, a template you can copy one field per line, the questions worth saving for the intake interview, how to word the safety section, what changes for couples, families and children, and where HIPAA and state law come in.
Every client in this article is invented. This is general guidance, not legal advice: the rules that apply to you depend on your state, your license and how you bill.
What an intake form is for, and what it isn't
An intake form collects the facts you would otherwise spend half of a first session gathering: contact details, what brings the client in, their history, medications, who else is involved in their care and how they are keeping safe. Read before the session, it also tells you what to ask first.
It is easy to ask a form to do jobs it can't do well. An intake form is:
- Not your consent to treatment.Informed consent covers how therapy works, your fees and cancellation policy, and the limits of confidentiality. The ethics codes treat it as a conversation with the client, not only a signature (APA Ethics Code, 10.01; ACA Code of Ethics, A.2; NASW Code of Ethics, 1.03). Keep it as its own document so a client can't miss it inside a questionnaire.
- Not an assessment.It gives you leads. The intake interview tests them, and your clinical judgment does the rest.
- Not a crisis line.A form can't respond to an answer. If you ask about safety, you need a plan for the day the answer is yes.
- Not your private notes.A completed form is part of the client's record, and under HIPAA clients can generally ask for a copy of their record (45 CFR 164.524). Ask only questions you'd be comfortable having the client read back, and keep your own comments off the form.
The intake packet: which document does which job
Most practices send a small packet rather than one long form. Splitting it keeps each document short and makes it obvious what the client is agreeing to.
- Intake questionnaire.Background and reasons for coming. Nothing in HIPAA requires one; it is clinical good practice.
- Consent to treatment.How therapy works, fees, cancellations, how to reach you between sessions, and the limits of confidentiality, such as mandatory reporting and duty-to-warn rules, which come from state law.
- Notice of Privacy Practices and acknowledgment.Required if HIPAA applies to you (see below).
- Telehealth consent.How online sessions work, what happens if the connection drops, and an emergency plan tied to where the client will be.
- Release of information.Permission to talk with another professional, such as a psychiatrist, a primary care provider or a school counselor.
- Safety and emergency contacts.Who to call in an emergency and when you would call them.
- Screening measures.Short standard questionnaires such as the PHQ-9 for depression, the GAD-7 for anxiety, the PC-PTSD-5 for post-traumatic stress and the AUDIT-C for alcohol use. Use the original wording: changing an item changes what the score means. The PHQ-9 and GAD-7 are published at phqscreeners.com, and the PC-PTSD-5 is in the public domain (VA National Center for PTSD).
- Good faith estimate.For clients who are uninsured or not using insurance (see the law section).
Send the questionnaire, consent and privacy notice before the first session. Releases and screeners can follow when you need them.
What to include on a therapy intake form
Here is what to ask in each section, and why it earns its place. The template below puts it all into wording you can copy.
Identity and contact
Legal name and the name the client wants you to use, pronouns, date of birth, phone, email and address. Ask whether it's all right to leave a voicemail or send an email: some clients share a phone or an inbox with the person they are coming to talk about. HIPAA gives clients the right to ask you to contact them by a particular method or at a particular place, and you should accommodate reasonable requests (HHS email FAQ).
Emergency contact
Name, relationship and phone, plus one sentence saying when you would use it. Match that sentence to your consent form. A client who lists a partner deserves to know you won't call them about a missed session.
What brings them in
The most useful field on the form. Ask in the client's own words and leave plenty of room. Then add a few quick closed questions: how long it has been going on, whether something changed recently, and how much it affects work or school, sleep and relationships. A short checklist of common concerns (low mood, anxiety, sleep, relationships, grief, anger, work stress) helps clients who freeze at a blank box.
Goals
"What would you like to be different by the end of our work together?" The answer is the first draft of a treatment plan goal, already in the client's words.
Past support and mental health history
Past therapy, and what helped or didn't. This is the most underrated question on any intake form: it tells you what to avoid repeating. Then any diagnosis a professional has given them, in their own words, and any hospital stays or intensive programs. Keep this section to yes or no and short answers; the details belong in the interview.
Health and medication
Current medications with dose and prescriber, medical conditions, the client's primary care provider, and sleep. Physical health problems and medication changes can affect mood, sleep and anxiety, so this section matters even if you never prescribe anything.
Alcohol and drug use
One or two plain questions, or a standard screen such as the AUDIT-C. Ask without judgment, and say why you ask: alcohol and drugs affect sleep, mood and how well other treatment works.
Safety
A few direct questions, a clear statement of who reads the form and when, and crisis numbers on the same page. There is a section on wording below.
Life now
Who they live with, relationship status, children, work or school, who they turn to for support, and current stress from money, housing, legal matters or caring for someone. Add one question about whether culture, faith or identity matters to how they want to work. It tells clients you're open to the conversation without making them explain themselves on page one.
Strengths
What they are good at and what has helped them through hard times before. It's quick to answer, it gives you something to build on, and for many clients it is the first thing on the form that feels good to write.
Practical details
How they found you, accessibility needs (hearing, vision, mobility, language, childcare), where they will be during online sessions, and how they will pay. For telehealth, the client's location matters because your license generally depends on where the client is during the session; check your board's rules.
A therapy intake form template you can copy
This counseling intake form template is written for adult individual therapy. Paste it into your form tool or a document, replace the parts in brackets, and delete anything you won't use. Each line is one field.
A few notes on using it:
- The safety lines make a promise. Replace "one business day" with a time you will actually keep, every week, including when you're away. If you can't keep any promise, say plainly that the form is not read quickly and move the safety questions to the first session.
- Delete the insurance lines if you only see self-pay clients, and add the fields your biller needs if you don't.
- Keep consent, the privacy notice acknowledgment, telehealth consent and releases separate. They need signatures and dates; this questionnaire only needs a name and date.
- Don't ask for a Social Security number unless your billing truly needs it. Every field you add is information you have to protect.
Turning it into a PDF
If you came here looking for a therapy intake form PDF: paste the template into a word processor, add your practice name and logo, and export it as a PDF. Most PDF editors can turn each line into a fillable field. Before you email it to anyone, read the email point in the law section below. A completed intake form sent back by ordinary email is a great deal of health information in one unencrypted message.
What to leave off the form and ask in person
A form is good at facts and bad at follow-up. Clients fill it in alone, often late in the evening, without knowing you yet. Some topics belong in the room, where you can respond to what you hear:
- Detailed trauma history. A yes or no screen is enough on paper. The story comes later, at the client's pace.
- The details of suicidal thoughts or past attempts. The form flags; you assess.
- Violence or fear at home, especially in couples work, where a partner may see the answers. Ask each partner privately.
- Sexual history, unless it is the reason they are coming.
- Legal history. A single yes or no with "we can talk about it" is plenty.
- Family history of mental illness, beyond one optional question.
Two rules of thumb. If you'd need to ask a follow-up question before an answer becomes useful, ask it in person. If you won't read or use an answer, don't ask the question.
Counseling intake interview questions for the first session
The form gives you leads; the intake interview turns them into a picture of the person. These are questions to choose from, not a script. Start with the form itself: "I read what you wrote. Is there anything you'd change or add?" Then follow the client.
For the safety questions, a structured tool such as the Columbia Suicide Severity Rating Scale gives you consistent wording and follow-up questions. Use the version and training your setting supports, and follow your own risk policy.
Before the session ends, summarize what you heard, agree on one or two goals in the client's words, explain how often you'll meet, and go over the limits of confidentiality out loud, even though they are in the consent form. After the session, your intake note is the first entry in the record. For progress notes from the second session on, see these BIRP note examples and SOAP note examples for therapy.
How to word the safety section
Asking about safety on a form is reasonable. Leaving the answers unread is not. Three things make the section safe to include:
- Say who reads the form and when. "I read this form within one business day" is a promise. Make it only if you'll keep it.
- Put crisis options on the same page as the questions: 911 for immediate danger, and 988, the Suicide and Crisis Lifeline, by call or text.
- Decide in advance what you do when an answer is yes. For example: call the client before the session, assess risk, agree on next steps and document what you did. Your state's law, your license and your liability insurer may all shape this plan.
The same goes for screeners. Item 9 of the PHQ-9 asks about thoughts of being better off dead or of hurting yourself. If you send the PHQ-9 before the first session, read item 9 as soon as the form comes back, not just the total score.
An invented example: reading a form before the first session
Invented client: a 38-year-old project manager we'll call Alex, booked for a first video session on Thursday. The form and a GAD-7 came back on Monday evening. Here is what Alex wrote:
- What brings you here:"I can't switch off. I lie awake going over work, and I've started snapping at my kids."
- How long:6 to 12 months. Effect on sleep and relationships: a lot. Work: some.
- Goal:"Sleep through the night and stop dreading Sunday evenings."
- Past therapy:six sessions in college. "Talking helped, but we never made a plan."
- Medication:an antidepressant from the primary care provider, started two months ago.
- Sleep and alcohol:about five hours a night; "a couple of glasses of wine most nights to wind down."
- Safety:no to all four questions.
- Online sessions from:home, in Ohio.
- GAD-7:total 13, which falls in the moderate range.
What the therapist notes in five minutes, before Thursday:
- Safety answers are all no. Still ask in person at the first session; a form is a starting point, not an assessment.
- A new medication. Ask how it's going and whether Alex would like you to talk with the prescriber. A signed release comes first.
- Wine most nights and five hours of sleep. Ask about amounts in the session and consider the AUDIT-C. Alcohol close to bedtime can make sleep worse, which is worth exploring together.
- "We never made a plan." Alex wants structure. Agree on goals and a rough plan in the first or second session.
- Ohio. Confirm you can see clients located in Ohio, and record the address Alex will be at for the telehealth emergency plan.
- First goal, in Alex's words: sleep through the night.
None of this is a diagnosis. It is an agenda for the first hour, and it took five minutes because the form asked the right things and nothing more.
Couples, family and child intake forms: what changes
Couples intake
- Each partner fills in their own copy, privately, instead of one shared form.
- Ask each partner, privately, about violence and fear in the relationship. Joint sessions are not safe for every couple, and answers on a shared form can be seen by the other partner.
- Decide your policy on secrets (what you do if one partner tells you something the other doesn't know) and put it in your consent form before you read anyone's private answers.
- Ask about relationship history, children, what each partner wants from therapy and how committed each feels to the relationship.
Family therapy intake
- Each member old enough to answer fills in their own copy; a parent answers for young children.
- Ask who lives in the home and who will come to sessions.
- Ask each person what they hope will change. Different answers are useful information, not a problem to fix on paper.
Child and adolescent intake
- A parent or guardian fills in the main form: concerns, development, health, school, recent family changes and the child's strengths.
- Ask who has legal authority to consent to treatment. With separated or divorced parents, ask for a copy of the custody order or the parenting plan's section on health care decisions. Whether one parent can consent alone depends on state law and the order itself.
- Ask whether the child knows they are coming to therapy and how they feel about it.
- Seek the young person's own agreement and involve them in decisions as far as their age allows (ACA Code of Ethics, A.2.d). For teenagers, a short form of their own often tells you more than the parent's.
Where HIPAA and state law come in
- Whether HIPAA applies to you.HIPAA covers health care providers, psychologists and therapists included, only if they send health information electronically in connection with a standard transaction, such as an insurance claim (HHS: covered entities). A therapist who only sees self-pay clients may not be a covered entity. State privacy and licensing rules apply either way, and HHS has a decision tool on that page if you are unsure. Many practices follow HIPAA from the start so nothing changes the day they bill a health plan.
- The privacy notice.If you are a covered entity, give clients your Notice of Privacy Practices no later than the first session and make a good faith effort to get a written acknowledgment that they received it. HHS adds that when the first service is delivered electronically, the notice should go out electronically, automatically, in response to the first request for service. If your practice website describes your services, the notice must be posted there too (HHS: Notice of Privacy Practices). HHS publishes model notices you can adapt.
- The form is part of the record.Clients can generally ask for a copy of their record, intake answers included (45 CFR 164.524). Store completed forms with the rest of the record, not in an email inbox or a downloads folder.
- Email.HHS says HIPAA does not ban unencrypted email between providers and patients, but you must use reasonable safeguards, such as checking the address and limiting what you send, and electronic health information must still meet the Security Rule. If a client doesn't want unencrypted email, offer another way (HHS email FAQ). A completed intake form is the riskiest kind of message, which is why most practices use a secure form tool rather than email attachments.
- Business associate agreements.If you are a covered entity, any company that stores intake answers for you (a form tool, records software, cloud storage) needs a business associate agreement with you. You can read TranqBay's business associate agreement before you store anything.
- Minors.Under HIPAA, a parent is usually the child's personal representative, with exceptions, including when state law lets a minor consent to their own mental health care and the minor does. HIPAA defers to state law on what parents can see (HHS: personal representatives). The age at which a minor can consent to therapy varies by state.
- Releases.If you use a HIPAA authorization to share information, it must describe the information, who may share it and with whom, the purpose, an expiration date or event, the client's signature and date, and the right to revoke it in writing (45 CFR 164.508). State mental health laws can be stricter than HIPAA, so many therapists get a signed release before any outside conversation.
- Self-pay clients and estimates.Under the No Surprises Act, if a client isn't using insurance, a provider usually must give a good faith estimate of expected charges when the client schedules at least three business days ahead or asks for one (CMS: good faith estimates). Many therapists include the estimate, or a notice that clients can ask for one, in the intake packet.
- State law.Mandatory reporting, duty to warn, the minor consent age, how long you keep records and what your consent form must say all come from your state. Your licensing board is the first place to check.
Paper, PDF or online form
- Paper in the office.Simple for in-person practices, but it eats into the first session or keeps the client in the waiting room, you need locked storage, and you have to type up anything you want in the record.
- PDF.Easy to make and print. Hard to fill in on a phone, and completed forms tend to come back by email or as photos, which raises the privacy issues above. You re-type the answers.
- Online form.Clients fill it in on a phone at their own pace, the answers land in the record, and reminders can go out for you. Check that the tool signs a business associate agreement, works well on a phone and lets clients skip questions.
How long a therapy intake form should be
Aim for something a client can finish in about 15 minutes, roughly the length of the template above. Longer forms invite skipped questions and rushed answers on exactly the items that matter most. Ways to keep it short:
- Ask for each fact once across the whole packet.
- Use choices where answers are predictable, and save open boxes for what matters.
- Say clearly that clients can skip questions and talk about them in person.
- Break it into short pages, especially on a phone.
- Send it two to three days before the first session, with a reminder, so you have time to read it.
Common intake form mistakes
- Consent hidden inside the questionnaire.Clients sign what they didn't read.
- Safety questions with no one reading the answers.Worse than not asking.
- Copying another practice's PDF.You inherit their state's rules, their policies and sometimes their name in the footer.
- Questions nobody uses.If the answer never changes what you do, cut it.
- Jargon."Do you experience anhedonia?" becomes "Have you lost interest in things you used to enjoy?"
- Fields that don't work on a phone.Many clients will fill in your form on one.
- A form that never changes.Review it when your fees, policies or state rules change, and at least once a year.
- Completed forms left in email.Move them into the record and delete the copies.
How this works in TranqBay
TranqBay is practice software for therapists in private practice: booking, video sessions, session notes and a practice website in one place. Intake forms work like this:
- A form library.There are ready-made templates clients fill in online before a session, including a general intake, couples intake, child and adolescent intake, family therapy intake, medical history, goals for therapy, consent to treat, telehealth consent, release of information, and safety and emergency contacts, plus the PHQ-9, GAD-7, PC-PTSD-5 and AUDIT-C screeners.
- Sent for a session.You send forms to a client for a specific session, and you can set a reminder for forms that aren't finished yet.
- Answers sit with the session.You can see what the client has completed from the session itself, so you can read the form before you meet.
- You do the scoring.Screeners aren't scored automatically. Add up the PHQ-9 or GAD-7 yourself, and read PHQ-9 item 9 on its own.
To see the booking steps a new client goes through before that first session, look at the walkthrough on practice.tranqbay.health.
Frequently asked questions about therapy intake forms
What should a therapy intake form include?
Contact details and an emergency contact, what brings the client in and for how long, goals, past therapy and mental health history, medications and health, alcohol and drug use, a short safety section with crisis numbers, current life and supports, strengths, and practical details such as telehealth location and payment. The template above covers all of these.
Is an intake form the same as informed consent?
No. The intake form gathers information about the client. Informed consent explains how therapy works, your fees and policies, and the limits of confidentiality, and records the client's agreement. Keep them as separate documents and talk the consent through at the first session.
Does HIPAA require an intake form?
No. HIPAA doesn't require an intake questionnaire. If HIPAA applies to you, it does require a Notice of Privacy Practices and a good faith effort to get a written acknowledgment that the client received it, and it protects the intake form once it's part of the record.
Can I email a therapy intake form as a PDF?
Sending a blank form by email is low risk. Getting a completed one back is different: it's health information, and HHS expects reasonable safeguards for email and lets clients ask for another method. A secure form tool, or paper at the first session, avoids the problem.
When should clients fill out the intake form?
Two to three days before the first session works well: close enough that the details are current, early enough that you can read the answers and follow up on anything urgent.
Can a client skip questions on an intake form?
Yes, and you should say so on the form. A skipped question is information too, and many clients answer more fully in the room once they've met you.
Who fills out an intake form for a child?
A parent or guardian with legal authority to consent fills in the main form. Older children and teenagers can fill in a short form of their own. State law decides when a minor can consent to their own therapy and what parents can see.
Do couples need separate intake forms?
It's best practice for each partner to fill in their own copy privately, especially for questions about safety and violence in the relationship.
Should intake forms be signed?
The questionnaire needs a name and a date. Consent to treatment, the privacy notice acknowledgment, telehealth consent and releases of information need signatures and dates.
Before your next new client
Copy the template, set your safety promise to something you'll keep, and send the form with your consent and privacy notice a few days before the first session. Then read it with the five-minute check from Alex's example and walk into the session with an agenda.
If you also want booking, video sessions, forms and session notes in one place, see how TranqBay works for private practice: you can look at a practice website template and the booking steps a new client goes through before you ever meet. If you're deciding whether to join, this page explains how joining TranqBay works.
Sources
HHS 5Regulations 2CMS 1988 Lifeline 1cssrs.columbia.edu 1Federal 1phqscreeners.com 1Associations 3
U.S. Department of Health and Human Services5
- 1Covered Entities and Business Associateshhs.govhttps://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
- 2Notice of Privacy Practices for Protected Health Informationhhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/privacy-practices-for-protected-health-information/index.html
- 3Model Notices of Privacy Practiceshhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/model-notices-privacy-practices/index.html
- 4Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?hhs.govhttps://www.hhs.gov/hipaa/for-professionals/faq/does-hipaa-permit-health-care-providers-to-use-email-to-discuss-health-issues-with-patients/index.html
- 5Personal Representativeshhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/personal-representatives/index.html
Laws and regulations2
- 645 CFR 164.508: uses and disclosures for which an authorization is required (eCFR)ecfr.govhttps://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.508
- 745 CFR 164.524: right of access to protected health information (eCFR)ecfr.govhttps://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.524
Centers for Medicare & Medicaid Services1
988 Suicide & Crisis Lifeline1
cssrs.columbia.edu1
Other federal agencies1
phqscreeners.com1
Professional associations3
- 13American Psychological Association, Ethical Principles of Psychologists and Code of Conductapa.orghttps://www.apa.org/ethics/code
- 14American Counseling Association, 2014 ACA Code of Ethicscounseling.orghttps://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf
- 15National Association of Social Workers, Code of Ethicssocialworkers.orghttps://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English